PUYALLUP TRIBAL HEALTH AUTHORITY, located in Tacoma, Washington is seeking a Claims Specialist.

“It is the mission of the Puyallup Tribal Health Authority to provide quality healthcare and promote wellness in a culturally appropriate manner.”

We offer an outstanding workplace, competitive market based salary, and benefits packages including:

• Monday – Friday schedule
• Medical/Dental/Vision benefits – monthly premiums paid 100% for employees
• 18+ annual paid holidays
• Generous paid sick and vacation accruals
• 401(k) with annual profit sharing
• Life & AD&D insurance coverage
• PTHA is an approved loan repayment site for various programs
• Employee Assistance Program
• Excellent work/home life balance

GENERAL FUNCTION: Provide assistance to PTHA patients in gaining access to health care services and eligibility for Referral Services coverage. Process receipts and disbursements for contracted services.

ESSENTIAL FUNCTIONS:

• Ensures that all IHS and Supplemental eligibility requirements are met prior to releasing claims for payment with 100% accuracy. Interpret alternate resource requirements and explain to health care providers and patients.
• Explain various programs, policies and procedures to patients such as and not limited to: Supplemental policy, contract care policy, referral policy, exclusion lists and other various organizational policies.
• Works closely with the referral services and Patient Access Team in collaboration to ensure the proper policies and procedures are followed.
• Ensures that all alternate resources have been exhausted for client before payment is authorized with 100% accuracy.
• Assist other Patient Accounts staff with claims as needed to minimize backlog.
• Review, document, adjudicate and process claims pursuant to established policy and procedures, with 100% accuracy.
• Research unpaid bills received from patients and providers. Review no Check List received from Third Party Administrator monthly.
• Review, process, research and document pended claims for eligibility, authorization of third party coverage and payment/denial determination, with 100% accuracy.

• High School Diploma or GED. 
• Two (2) years’ administrative/customer service experience in a health care setting.
• Experience and/or ability to work with an Electronic Health System.
• Must have good computer skills and proficiency in MS Office products (Word, Excel, Outlook, etc.).
• Application and utilization knowledge of: private insurance plans, state Medicaid programs and Medicare.
• Demonstrable knowledge of claims processing to include coordination of benefits, understanding of CPT and ICD-10 coding, medical and dental terminology.